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Figuras y tablas -
Figure 1
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Quality of life

Study

Measure

Home‐like

Traditional

Sample size

Reported significance

Wolf‐Ostermann 2012

QUALIDEM 

‐Feeling at home (adjusted, mean)

(higher scores = better)

Baseline: 55.1

6 months: 65.5

12 months: 77.4

Baseline: 58.7

6 months: 65.5

12 months: 83.2

33

Group differences in trends over time adjusted for gender and stage of dementia:

P = 0.674

 

QUALIDEM

‐Care relationship (adjusted, mean)

(higher scores = better)

Baseline: 68.2

6 months: 74.2

12 months: 90.5

Baseline: 69.5

6 months: 58.0

12 months: 58.9

33

P = 0.065

QUALIDEM

‐Positive affect (unadjusted mean (SD))

(higher scores = better)

Baseline: 64.3 (24.7)

6 months: 75.0 (23.2)

12 months: 79.2 (20.0)

Baseline: 68.8 (21.7)

6 months: 76.5 (23.3)

12 months: 81.2 (23.5)

33

P = 0.683

QUALIDEM

‐Negative affect (unadjusted mean (SD))

(higher scores = better)

Baseline: 49.4 (28.7)

6 months: 53.6 (25.7)

12 months: 61.7 (23.0)

Baseline: 57.7 (30.6)

6 months: 59.8 (22.2)

12 months: 58.5 (30.0)

33

P = 0.373

QUALIDEM

‐Social isolation (unadjusted, mean (SD))

(higher scores = better)

Baseline: 77.8 (20.7)

6 months: 70.6 (24.3)

12 months: 67.8 (22.2)

Baseline: 61.5 (25.9)

6 months: 63.2 (26.6)

12 months: 59.8 (28.8)

33

P = 0.456

QUALIDEM

‐Social relations (unadjusted, mean (SD))

(higher scores = better)

Baseline: 61.1 (22.1)

6 months: 67.5 (22.9)

12 months: 68.1 (18.8)

Baseline: 47.9 (17.5)

6 months: 66.2 (20.7)

12 months: 59.8 (14.9)

33

P = 0.947

QUALIDEM

‐Positive self‐image (unadjusted, mean (SD))

(higher scores = better)

Baseline: 67.8 (28.9)

6 months: 62.0 (23.5)

12 months: 68.6 (25.5)

Baseline: 69.7 (26.3)

6 months: 65.3 (33.8)

12 months: 68.5 (33.8)

33

P = 0.990

QUALIDEM

‐Restless tense behaviour (unadjusted, mean (SD))

(higher scores = better)

Baseline: 46.7 (34.3)

6 months: 53.9 (32.1)

12 months: 53.9 (36.3)

Baseline: 45.3 (32.9)

6 months: 54.7 (35.0)

12 months: 54.7 (32.9)

33

P = 0.226

QUALIDEM

‐Having something to do (unadjusted, mean (SD)),

(higher scores = better)

Baseline: 52.6 (32.5)

6 months: 51.8 (64.6)

12 months: 53.9 (33.1)

Baseline: 29.2 (28.8)

6 months: 62.5 (24.8)

12 months: 55.6 (33.6)

33

P = 0.878

Figuras y tablas -
Analysis 1.1

Comparison 1: Home‐like vs. traditional environment, Outcome 1: Quality of life

Ir a la figura de la revisión

Behaviour, mood and depression

Study

Measure

Home‐like

Traditional

Sample size

Effect estimate or reported significance

Global behaviour

Dettbarn‐Reggentin 2005

Nurses Observation Scale for Geriatric Patients (NOSGER) (unadjusted mean)

(lower scores = better)

Baseline 15.9

6 months 16.0

12 months 15.3

Baseline 18.0

6 months 18.8

12 months 19.6

60

P < 0.01 at baseline

P < 0.001 at 6 months

P < 0.0001 at 12 months

Te Boekhorst 2009

Neuropsychiatric Inventory (NPI) (unadjusted mean (95% confidence interval))

(lower scores = better)

Baseline: 12.1 (10.5 to 13.8)

6 months: 7.5 (6.2 to 6.7)

Baseline: 11.7 (10.9 to 12.8)

6 months 8.8 (7.5 to 10.1)

164

Adjusted MD for global behaviour change over 6 months:

‐0.04 (95% CI ‐0.13 to 0.04) 

Wolf‐Ostermann 2012

Neuropsychiatric Inventory‐Nursing Home version (NPI‐NH) (adjusted mean)

(lower scores = better)

Baseline 47.3

6 months 26.7

12 months 17.4

Baseline 34.1

6 months 36.6

12 months 20.5

Baseline: 56

12 months: 33

P > 0.05

Depression

Te Boekhorst 2009

Revised Memory and Behaviour Problems Checklist (RMBPC) (unadjusted mean (95% confidence interval))

(lower scores = better)

Baseline 14.9 (12.8 to 17.0)

6 months 8.9 (7.4 to 10.5)

Baseline 13.1 (12.3 to 13.8)

6 months 8.0 (7.4 to 8.6)

164

Adjusted MD (95% confidence interval) for global behaviour change over 6 months:

0.01 (‐0.12 to 0.14)

Yoon 2015

Mood Scale Score (MSS)

(lower scores = better)

N/R

N/R

242

Adjusted RR (95% confidence interval) for level of social engagement over 18 months: 

1.15 (1.02 to 1.29)

Adjusted OR (95% confidence interval) for probability of not being socially engaged over 18 months:

0.36 (0.12 to 1.07)

Behaviour subdomains

Annerstedt 1993

Organic Brain Syndrome (OBS) scale

‐Dyspraxia (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

0.95 (0.49)

0‐12 months:

0.57 (0.49)

0‐6 months:

0.54 (0.54)

0‐12 months:

0.69 (0.69)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P < 0.001

0‐12 months: P > 0.05

 OBS scale

‐Hallucinations (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

0.02 (0.29)

0‐12 months:

0.14 (0.47)

0‐6 months:

0.03 (0.36)

0‐12 months:

0.14 (0.41)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P > 0.05

0‐12 months: P > 0.05

OBS scale

‐Lack of vitality (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

0.05 (0.49)

0‐12 months:

0.63 (0.52)

0‐6 months:

0.24 (0.47)

0‐12 months:

0.31 (0.55)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P > 0.05

0‐12 months: P < 0.05

OBS scale

‐Dysphasia (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

0.04 (0.56)

0‐12 months:

0.63 (0.52)

0‐6 months:

0.36 (0.48)

0‐12 months:

0.42 (0.70)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P < 0.05

0‐12 months: P > 0.05

OBS scale

‐Paranoia (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

‐0.05 (0.32)

0‐12 months:

0.44 (0.40)

0‐6 months:

0.17 (0.37)

0‐12 months:

0.28 (0.41)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P < 0.05

0‐12 months: P > 0.05

OBS scale

‐Aggressiveness (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

0.22 (0.51)

0‐12 months:

0.45 (0.45)

0‐6 months:

0.09 (0.58)

0‐12 months:

0.07 (0.41)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P > 0.05

0‐12 months: P < 0.01

OBS scale

‐Depression, anxiousness (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

‐0.19 (0.23)

0‐12 months:

0.32 (0.50)

0‐6 months:

0.28 (0.60)

0‐12 months:

0.30 (0.49)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P < 0.01

0‐12 months: P > 0.05

OBS scale

‐Clinical variations (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

0.06 (0.54)

0‐12 months:

0.65 (0.65)

0‐6 months:

0.29 (0.75)

0‐12 months:

0.16 (0.68)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P > 0.05

0‐12 months: P < 0.05

OBS scale

‐Restlessness (unadjusted mean (SD))

(lower scores = better)

0‐6 months:

‐0.11 (0.28)

0‐12 months:

0.22 (0.53)

0‐6 months:

0.09 (0.38)

0‐12 months:

0.26 (0.58)

0‐6 months:

53

0‐12 months:

44

0‐6 months: P < 0.05

0‐12 months: P > 0.05

Wolf‐Ostermann 2012

Cohen‐Mansfield Agitation Inventory (CMAI), proportion with physical non‐aggressive behaviour

(lower scores = better)

Baseline: 35.0%

6 months: 40.0%

12 months: 30.0%

Baseline: 46.2%

6 months: 46.2%

12 months: 53.8%

33

P > 0.05

CMAI, proportion with verbal agitation

(lower scores = better)

Baseline: 50.0%

6 months: 50.0%

12 months: 40.0%

Baseline: 30.8%

6 months: 53.8%

12 months: 61.5%

33

P > 0.05

CMAI, proportion with physical aggressive behaviour

(lower scores = better)

Baseline: 0%

6 months: 5.0%

12 months: 25.0%

Baseline: 30.8%

6 months: 30.8%

12 months: 30.8%

33

P = 0.066 for baseline to 6 months 

P > 0.05 for baseline to 12 months

Social engagement

Te Boekhorst 2009

Revised Index of Social Engagement (RISE) 

(unadjusted mean (95% confidence interval))

(higher scores = better)

 

Baseline 3.2 (2.7 to 3.7)

6 months 4.5 (4.0 to 5.0)

Baseline 2.9 (2.5 to 3.2)

6 months 3.2 (2.6 t0 3.7)

164

Adjusted MD (95% confidence interval) for global behaviour change over 6 months:

0.79 (0.11 to 1.50)

Yoon 2015

Index of Social Engagement (ISE) 

(higher scores = better)

N/R

N/R

242

Adjusted RR (95% confiedence interval) for level of social engagement over 18 months:

0.99 (0.82 to 1.19)

Adjusted OR (95% confidence interval) for probability of not being socially engaged over 18 months:

0.76 (0.62 to 0.94)

Figuras y tablas -
Analysis 1.2

Comparison 1: Home‐like vs. traditional environment, Outcome 2: Behaviour, mood and depression

Ir a la figura de la revisión

Function

Study

Measure

Home‐like

Traditional

Sample size

Effect estimate or reported significance

Dettbarn‐Reggentin 2005

Barthel Index (unadjusted mean)

(higher scores = better)

Baseline: 40.9

12 months: 35.9

Baseline: 35.9

12 months: 23.9

60

P = 0.039

Te Boekhorst 2009

The Interview for the Deterioration of Daily Living activities in Dementia (IDDD) (unadjusted mean (95% confidence interval)) 

(lower scores = better)

Baseline 25.9 

(22.9 to 28.8)

6 months 28.3 

(26.3 to 30.3)

Baseline 33.0 

(30.5 to 35.6)

6 months 34.6 

(31.9 to 37.2)

164

Adjusted MD (95% confidence interval) over six months:

‐4.37 (‐7.06 to ‐1.69)

Wolf‐Ostermann 2012

Barthel Index  (adjusted mean)

(higher scores = better)

Baseline: 58.6

6 months: 43.7

12 months: 36.2

Baseline: 64.8

6 months: 46.3

12 months: 49.8

Baseline: 56

Follow‐up: 33

Interactions between setting and development over time, P > 0.05

Bathing‐decrease in proportion independent 12 months (%, N)

10.0%

7.7%

33

‐

Toilet use‐decrease in proportion independent 12 months (%, N)

30.0%

23.1%

33

‐

Grooming‐decrease in proportion independent 12 months (%, N)

15.0%

15.4%

33

‐

Bladder‐decrease in proportion independent 12 months (%, N)

15.0%

15.4%

33

‐

Stairs‐decrease in proportion independent 12 months(%, N)

20.0%

0%

33

‐

Feeding‐decrease in proportion independent 12 months (%, N)

20.0%

15.4%

33

‐

Dressing‐decrease in proportion independent 12 months (%, N)

15.0%

7.7%

33

‐

Transferring‐decrease in proportion independent 12 months (%, N)

15.0%

7.7%

33

‐

Yoon 2015

Activities of daily living (ADL) long‐form scale (unadjusted mean (SD))

(lower scores = better)

Baseline: 14.5 (6.7)

6 months: 15.6 (6.9)

18 months: 18.5 (4.4)

Baseline: 14.5 (7.4)

 6 months: 15.1 (7.3)

18 months: 16.9 (7.0)

Baseline n = 242

6 months

n = 238

18 months

n = 92

Adjusted MD (95% confidence interval) over 18 months: ‐0.09 (‐0.46 to 0.28)

 

Figuras y tablas -
Analysis 1.3

Comparison 1: Home‐like vs. traditional environment, Outcome 3: Function

Ir a la figura de la revisión

Global cognitive function

Study

Measure

Home‐like

Traditional

Sample size

Effect estimate or reported significance

Dettbarn‐Reggentin 2005

Mini‐Mental State Examination (MMSE) (unadjusted mean)

(higher scores = better)

Baseline: 10.3

12 months: 9.9

Baseline: 9.1

12 months: 7.6

60

P = 0.0082

Te Boekhorst 2009

Standardised Mini‐Mental State Examination (MMSE) (unadjusted mean (95% confidence interval))

(higher scores = better)

Baseline 15.4 (13.5 to 17.3)

6 months 13.0 (10.4 to 15.6)

Baseline 10.3 (8.3 to 12.3)

6 months 8.9 (6.2 to 11.6)

164

Adjusted MD (95% confidence interval) over 6 months:

0.54 (‐1.43 to 2.50)

Wolf‐Ostermann 2012

Mini‐Mental State Examination (MMSE) (unadjusted mean (SD))

(higher scores = better)

Baseline: 15.7 (6.9)

6 months: 13.8 (6.8)

12 months: 10.8 (10.0)

Baseline: 12.4 (6.5)

6 months: 8.4 (7.4)

12 months: 8.7 (7.7)

33

P = 0.004 for baseline to 6 months

P > 0.05 for baseline to 12 months

Yoon 2015

Cognitive Performance Scale (CPS) (unadjusted mean (SD))

(lower scores = better)

Baseline: 2.5 (1.0)

6 months: 2.6 (1.1)

18 months: 2.9 (1.3)

Baseline: 2.2 (1.2)

6 months: 2.3 (1.3)

18 months: 2.3 (1.5)

Baseline 

n = 242

6 months

n=238

18 months

n=92

N/R

Figuras y tablas -
Analysis 1.4

Comparison 1: Home‐like vs. traditional environment, Outcome 4: Global cognitive function

Ir a la figura de la revisión

Quality of care 

Study

Measure

Sample size

Effect estimate (unclear follow‐up time, reported as up to 5 years)

Afendulis 2016

Number of bedfast residents

Estimated weighted sample 74,449 

Adjusted MD (95% confidence interval)

‐0.3% (‐0.4% to ‐0.2%)

Catheter use

Estimated weighted sample 74,449 

Adjusted MD (95% confidence interval)

‐4.1% (‐6.1% to ‐2.1%)

High‐risk pressure ulcers

Estimated weighted sample 74,449

Adjusted MD (95% confidence interval)

‐1.2% (‐3.8% to 1.4%)

Low‐risk pressure ulcers

Estimated weighted sample 74,449

Adjusted MD (95% confidence interval)

‐1.9% (‐2.5% to ‐1.3%)

Hospital readmissions

Estimated weighted sample 74,449

MD (95% confidence interval)

‐5.5% (‐10.2% to ‐0.8%)

Avoidable hospital readmissions

Estimated weighted sample 74,449

MD (95% confidence interval)

‐3.9% (‐7.6% to ‐0.2%)

Figuras y tablas -
Analysis 1.5

Comparison 1: Home‐like vs. traditional environment, Outcome 5: Quality of care 

Ir a la figura de la revisión

Serious adverse effects

Study

Measure

Sample size

Effect estimate (unclear follow‐up, reported as up to 5 years)

Afendulis 2016

Physical restraints

Estimated weighted sample 74,449

Adjusted MD (95% confidence interval):

‐0.3% (‐0.5% to ‐0.1%)

Figuras y tablas -
Analysis 1.6

Comparison 1: Home‐like vs. traditional environment, Outcome 6: Serious adverse effects

Ir a la figura de la revisión

Quality of life

Study

Measure

Refurbishment

Traditional

Sample size

Effect estimate or reported significance

Chenoweth 2014

Dementia quality of life (DEMQOL) Proxy (adjusted mean (95% confidence interval))

(higher scores = better)

Person‐centred environment (PCE)

Baseline: 101 (99 to 104)

Post‐intervention: 102 (99 to 105)

8 months: 106 (103 to 110)

PCE + person‐centred care (PCC)

Baseline: 101 (99 to 104)

Post‐intervention: 103 (100 to 106)

8 months: 105 (102 to 108)

Baseline: 101 (98 to 104)

Post‐intervention: 100 (97 to 104)

8 months: 103 (99 to 106)

Baseline: 601

Post‐intervention: 416

8 months: 296

Adjusted MD (95% confidence interval)

PCE vs. traditional: 

Post‐intervention: 2.00 (‐2.19 to 6.19)

8 months: 3.00 (‐1.91 to 7.91)

PCE + PCC vs traditional:

Post‐intervention: 3.00 (‐1.20 to 7.20)

8 months: 2.00 (‐2.91 to 6.91)

Diaz‐Veiga 2014

Fumat for mild cognitive impairment (unadjusted mean (SD))

(higher scores = better)

Baseline: 100.6 (8.0)

6 months: 104.5 (8.0)

Baseline: 107.1 (11.1)

6 months: not reported

Unclear

P = 0.850

Qualid for severe cognitive impairment (unadjusted mean (SD))

(lower scores = better)

Baseline: 27.4 (12.1)

6 months: 23.8 (12.4)

Baseline: not reported

6 months: 30.8 (11.1)

Unclear

P = 0.33

Wylie 2001

Life Satisfaction Index (unadjusted mean (SD))

(higher scores = better)

Baseline: 12.0 (4.1)

6 months: 11.2 (3.4)

12 months: 12.1 (3.3)

18 months: 12.6 (3.3)

Baseline: 12.0 (3.9)

6 months: 11.1 (3.6)

12 months: 11.3 (3.3)

18 months: 11.1 (3.4)

Baseline: 100

6 months: 70

12 months: 43

18 months: 33

'Not significant'

Figuras y tablas -
Analysis 2.1

Comparison 2: Refurbishment vs. traditional environment, Outcome 1: Quality of life

Ir a la figura de la revisión

Behaviour, mood and depression

Study

Measure

Refurbishment

Traditional

Sample size

Effect measure or reported significance

Depression

Galik 2021

Cornell Scale for Depression in Dementia (CSDD) (unadjusted mean (SD))

(lower scores = better)

Baseline: 4.5 (4.2)

4 months: 4.4 (4.6)

12 months: 3.9 (4.5)

Baseline: 3.9 (3.8)

4 months: 4.2 (4.3)

12 months: 3.2 (3.5)

336

Adjusted MD (95% confidence interval) baseline to 4 months:

‐0.73 (‐1.93 to 0.47)

Adjusted MD (95% confidence interval) baseline to 12 months:

‐0.04 (‐1.35 to 1.26)

Behaviour subdomains

Burack 2012

Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean)

Physical agitation

(lower scores = better)

Baseline: 1.68

Two years: 1.44

Baseline: 1.24

Two years: 1.51

101

Adjusted MD (95% confidence interval):

‐0.07 (‐0.14 to ‐0.00)

Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean)

Forceful behaviours

(lower scores = better)

Baseline: 1.50

Two years: 1.35

Baseline: 1.21

Two years: 1.41

101

Adjusted MD (95% confidence interval):

‐0.06 (‐0.10 to ‐0.02)

Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean)

Verbal agitation

(lower scores = better)

Baseline: 2.13

Two years: 1.95

Baseline: 1.48

Two years: 2.06

101

Adjusted MD (95% confidence interval):

0.11 (‐0.00 to 0.22)

Chenoweth 2014

Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean (95% confidence interval))

(lower scores = better)

Person‐centred environment (PCE)

Baseline: 65 (57 to 73)

Post‐intervention: 55 (46 to 64)

8 months: 55 (46 to 64)

PCE + person‐centred care (PCC)

Baseline: 57 (49 to 65)

Post‐intervention: 60 (52 to 69)

8 months: 64 (55 to 73)

Baseline: 52 (43 to 61)

Post‐intervention: 53 (43 to 63)

8 months: 51 (41 to 62)

Baseline: 601

Post‐intervention: 416

8 months: 296

Adjusted MD (95% confidence interval)

PCE vs. traditional: 

Post‐intervention: 2.00 (‐11.29 to 15.29)

8 months: 4.00 (‐9.21 to 17.21)

PCE + PCC vs traditional:

Post‐intervention: 7.00 (‐5.66 to 19.66)

8 months: 13.00 (‐0.22 to 26.22)

Galik 2021

Cohen Mansfield Agitation Inventory (CMAI) (unadjusted mean (SD))

(lower scores = better)

Baseline: 19.8 (6.1)

4 months: 19.2 (5.9)

12 months: 19.2 (7.8)

Baseline: 20.2 (6.6)

4 months: 19.7 (6.8)

12 months: 18.9 (5.6)

336

Adjusted MD (95% confidence interval) baseline to 4 months:

‐0.72 (‐2.63 to 1.20)

Adjusted MD (95% confidence interval) baseline to 12 months:

‐0.36 (‐2.41 to 1.69)

Resistiveness to Care scale (unadjusted mean (SD))

(lower scores = better)

Baseline: 0.83 (2.15)

4 months: 0.10 (0.48)

12 months: 0.81 (2.40)

Baseline: 0.65 (1.62)

4 months: 0.46 (1.34)

12 months: 0.59 (1.85)

336

Adjusted MD (95% confidence interval) baseline to 4 months:

‐1.56 (‐2.71 to ‐0.40)

Adjusted MD (95% confidence interval) baseline to 12 months:

0.32 (‐0.29 to 0.94)

Figuras y tablas -
Analysis 2.2

Comparison 2: Refurbishment vs. traditional environment, Outcome 2: Behaviour, mood and depression

Ir a la figura de la revisión

Function

Study

Measure

Refurbishment, mean

Traditional, mean

Sample size

Effect size

Galik 2021

Barthel Index (unadjusted mean (SD))

(higher scores = better)

Baseline: 45.2 (27.8)

4 months: 44.0 (28.4)

12 months: 42.2 (25.7)

Baseline: 47.6 (27.0)

4 months: 47.9 (28.1)

12 months: 42.2 (25.4)

336

Adjusted MD (95% confidence interval) baseline to 4 months:

1.24 (‐3.34 to 5.81)

Adjusted MD (95% confidence interval) baseline to 12 months:

1.49 (‐3.53 to 6.50)

Figuras y tablas -
Analysis 2.3

Comparison 2: Refurbishment vs. traditional environment, Outcome 3: Function

Ir a la figura de la revisión

Quality of care

Study

Measure

Refurbishment

Traditional

Sample size

Effect estimate

Chenoweth 2014

Quality of Interactions Schedule (QUIS) (adjusted mean (95% confidence interval))

(higher scores = better)

Person‐centred environment (PCE)

Baseline: 78 (74 to 83)

Post‐intervention: 81 (76 to 85)

8 months: 82 (76 to 87)

PCE + person‐centred care (PCC)

Baseline: 76 (72 to 81)

Post‐intervention: 86 (81 to 91)

8 months: 80 (75 to 85)

Baseline: 78 (73 to 83)

Post‐intervention: 73 (68 to 79)

8 months: 82 (76 to 88)

Baseline: 601

Post‐intervention: 416

8 months: 296

Adjusted MD (95% confidence interval)

PCE vs. traditional: 

Post‐intervention: 8.00 (1.03 to 14.97)

8 months: MD 0.00 (‐8.34 to 8.34)

PCE + PCC vs traditional:

Post‐intervention: 13.00 (6.02 to 19.98)

8 months: ‐2.00 (‐9.67 to 5.67)

Figuras y tablas -
Analysis 2.4

Comparison 2: Refurbishment vs. traditional environment, Outcome 4: Quality of care

Ir a la figura de la revisión

Behaviour, mood and depression

Study

Measure

Special care units

Traditional

Sample size

Reported significance

Global behaviour

Frisoni 1998

Neuropsychiatric Inventory (NPI) (unadjusted mean (SD))

(lower scores = better)

Baseline: 39.2 (18.1)

3 months: 29.0 (15.0)

Baseline: 29.2 (13.8)

3 months: 20.5 (11.1)

66

P = 0.007 for intervention
P = 0.006 for comparator

Depression

Frisoni 1998

Cornell Depression Scale (unadjusted mean (SD))

(lower scores = better)

Baseline: 10.7 (4.6)

3 months: 8.4 (3.4)

Baseline: 6.5 (3.5)

3 months: 10.5 (5.9)

66

P = 0.03 for intervention
P = 0.004 for comparator

Behaviour subdomains

Frisoni 1998

Neuropsychiatric Inventory (NPI)

‐delusions (unadjusted mean (SD))

(lower scores = better)

Baseline: 4.4 (4.6)

3 months: 2.8 (3.7)

Baseline: 3.0 (4.1)

3 months: 2.2 (3.4)

66

P = 0.06 for intervention
P > 0.05 for comparator

NPI

‐hallucinations (unadjusted mean (SD))

(lower scores = better)

Baseline: 2.9 (4.5)

3 months: 1.2 (2.6)

Baseline: 1.3 (2.7)

3 months: 0.8 (1.8)

66

p=0.004 for intervention
p>0.05 for comparator

NPI

‐agitation (unadjusted mean (SD))

(lower scores = better)

Baseline: 5.4 (4.4)

3 months: 3.8 (3.5)

Baseline: 3.5 (4.0)

3 months: 2.5 (2.9)

66

p=0.02 for intervention
p>0.05 for comparator

NPI

‐anxiety (unadjusted mean (SD))

(lower scores = better)

Baseline: 4.8 (4.5)

3 months: 4.0 (4.0)

Baseline: 3.7 (3.9)

3 months: 2.6 (4.1)

66

p>0.05 for intervention
p=0.04 for comparator

NPI

‐euphoria/elation (unadjusted mean (SD))

(lower scores = better)

Baseline: 1.2 (2.6)

3 months: 1.2 (2.7)

Baseline: 1.4 (3.1)

3 months: 0.6 (1.7)

66

p>0.05 for intervention
p=0.04 for comparator

NPI

‐disinhibition (unadjusted mean (SD))

(lower scores = better)

Baseline: 2.0 (3.5)

3 months: 2.0 (3.0)

Baseline: 1.6 (3.5)

3 months: 1.4 (2.5)

66

p>0.05 for intervention
p>0.05 for comparator

NPI

‐irritability/lability (unadjusted mean (SD))

(lower scores = better)

Baseline: 4.7 (4.6)

3 months: 4.7 (3.7)

Baseline: 2.9 (4.0)

3 months: 1.9 (2.8)

66

p>0.05 for intervention
p=0.05 for comparator

NPI

‐abnormal motor behaviour (unadjusted mean (SD))

(lower scores = better)

Baseline: 9.0 (4.3)

3 months: 7.5 (5.0)

Baseline: 8.2 (4.7)

3 months: 6.9 (4.7)

66

p>0.05 for intervention
p>0.05 for comparator

NPI

‐sleep (unadjusted mean (SD))

(lower scores = better)

Baseline: 4.8 (4.9)

3 months: 2.3 (3.1)

Baseline: 3.9 (4.2)

3 months: 1.7 (3.3)

66

p=0.01 for intervention
p=0.02 for comparator

Cohen Mansfield Inventory (CMAI) (unadjusted mean, SD)

(lower scores = better)

Baseline: 40.7 (24.6)

3 months: 36.4 (17.8)

Baseline: 31.2 (14.3)

3 months: 26.7 (11.8)

66

p>0.05 for intervention
p>0.05 for comparator

Figuras y tablas -
Analysis 3.1

Comparison 3: Special‐care units for dementia vs. traditional environment, Outcome 1: Behaviour, mood and depression

Ir a la figura de la revisión

Function

Study

Measure

Special care units

Traditional

Sample size

Reported significance

Frisoni 1998

Bedford Alzheimer's nursing severity scale (unadjusted mean (SD))

(higher scores = better)

Baseline: 13.5 (3.5)

3 months: 14.0 (4.3)

Baseline: 13.8 (3.9)

3 months: 14.1 (4.7)

66

P > 0.05 for intervention
P > 0.05 for comparator

Barthel Index (unadjusted mean (SD))

(higher scores = better)

Baseline: 60.7 (23.5)

3 months: 57.5 (26.3)

Baseline: 52.7 (28.1)

3 months: 45.9 (30.2)

66

P > 0.05 for intervention
P > 0.05 for comparator

Figuras y tablas -
Analysis 3.2

Comparison 3: Special‐care units for dementia vs. traditional environment, Outcome 2: Function

Ir a la figura de la revisión

Global cognitive function

Study

Measure

Special care units

Traditional

Sample size

Reported significance

Frisoni 1998

MMSE (unadjusted mean (SD))

(higher scores = better)

Baseline: 7.0 (5.2)3 months: 7.4 (5.8)

Baseline: 8.3 (5.1)3 months: 8.9 (6.2)

66

P > 0.05 for intervention
P > 0.05 for comparator

Clinical Dementia Rating (unadjusted mean (SD))

(lower scores = better)

Baseline: 2.8 (0.5)

3 months: 2.9 (0.5)

Baseline: 2.9 (0.5)

3 months: 3.0 (0.5)

66

P > 0.05 for intervention
P > 0.05 for comparator

Figuras y tablas -
Analysis 3.3

Comparison 3: Special‐care units for dementia vs. traditional environment, Outcome 3: Global cognitive function

Ir a la figura de la revisión

Behaviour, mood and depression

Study

Measure

Sample size

Adjusted OR (95% confidence interval)

Depression

Elmstahl 1997

Organic Brain Syndrome (OBS) scale

(lower scores = better)

105

8.82 (1.14 to 68.22)

Behaviour subdomains

Elmstahl 1997

Organic Brain Syndrome (OBS) scale

Aggressiveness

(lower scores = better)

105

2.02 (0.56 to 7.27)

Organic Brain Syndrome (OBS) scale

Dyspraxia

(lower scores = better)

105

4.57 (0.76 to 27.35)

Organic Brain Syndrome (OBS) scale

Hallucinations

(lower scores = better)

105

1.06 (0.05 to 22.09)

Organic Brain Syndrome (OBS) scale

Lack of vitality

(lower scores = better)

105

0.23 (0.04 to 1.47)

Organic Brain Syndrome (OBS) scale

Dysphasia

(lower scores = better)

105

0.87 (0.08 to 9.73)

Organic Brain Syndrome (OBS) scale

Paranoia

(lower scores = better)

105

0.12 (0.01 to 1.24)

Organic Brain Syndrome (OBS) scale

Restlessness

(lower scores = better)

105

0.21 (0.04 to 1.00)

Organic Brain Syndrome (OBS) scale

Disorientation, recent memory

(lower scores = better)

105

0.87 (0.31 to 2.42)

Organic Brain Syndrome (OBS) scale

Disorientation, time

(lower scores = better)

105

0.66 (0.22 to 2.01)

Organic Brain Syndrome (OBS) scale

Disorientation, identity

(lower scores = better)

105

1.23 (0.56 to 2.68)

Figuras y tablas -
Analysis 4.1

Comparison 4: Group living corridor vs. group living non‐corridor design, Outcome 1: Behaviour, mood and depression

Ir a la figura de la revisión

Behaviour, mood and depression

Study

Measure

Lighting intervention

Control lighting

Sample size

Effect estimate

Global behaviour

Riemersma‐vanDerLek 2008

Questionnaire format of the NPI (NPI‐Q) (mean (SD))

(lower scores = better)

6 weeks: 4.7 (5.0)

6 months: 5.7 (5.7)

12 months: 5.8 (5.7)

18 months: 4.0 (4.6)

24 months: 4.9 (5.8)

6 weeks: 6.4 (5.3)

6 months: 5.2 (4.4)

12 months: 6.1 (3.5)

18 months: 6.8 (5.0)

24 months: 8.2 (3.9)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 weeks: ‐1.70 (‐3.88 to 0.48)

6 months: 0.50 (‐1.80 to 2.80)

12 months: ‐0.30 (‐2.73 to 2.13)

18 months: ‐2.80 (‐5.78 to 0.18)

24 months: ‐3.30 (‐7.27 to 0.67)

Depression

Riemersma‐vanDerLek 2008

 Cornell Scale for Depression in Dementia (CSDD) , (mean, SD)

(lower scores = better)

6 months: 7.9 (5.6)

12 months: 11.0 (7.7)

18 months: 9.9 (5.9)

24 months: 10.7 (7.3)

6 months: 9.3 (6.1)

12 months: 11.3 (7.4)

18 months: 12.0 (7.5)

24 months: 15.1 (8.6)

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 months: ‐0.24 (‐0.70 to 0.23)

12 months: ‐0.04 (‐0.58 to 0.50)

18 months: 0.31 (‐0.93 to 0.31)

24 months: ‐0.55 (‐1.35 to 0.26)

Behaviour subdomains

Hopkins 2017

Anxiety

Anxiety subset of the hospital anxiety and depression (HADA) scale (mean (SD))

(lower scores = better)

4 weeks: 4.5 (2.5)

4 weeks: 4.7 (2.7)

42

MD (95% confidence interval):

‐0.10 (‐1.67 to 1.47)

Riemersma‐vanDerLek 2008

Distress

Questionnaire format of the NPI (NPI‐Q) distress subdomain (mean (SD))

(lower scores = better)

6 weeks: 5.1 (6.0)

6 months: 6.1 (7.4)

12 months: 6.0 (7.2)

18 months: 4.2 (5.3)

24 months: 5.4 (6.8)

6 weeks: 6.0 (5.9)

6 months: 3.6 (4.6)

12 months: 3.2 (3.5)

18 months: 4.2 (4.6)

24 months: 7.4 (4.5)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 weeks: ‐0.90 (‐3.41 to 1.61)

6 months: 2.50 (‐0.24 to 5.24)

12 months: 2.80 (‐0.06 to 5.66)

18 months: ‐0.00 (‐3.03 to 3.03)

24 months: ‐2.00 (‐6.35 to 2.35)

Withdrawn behaviour 

Multi Observational Scale for Elderly Subjects (MOSES) (mean (SD))

(lower scores = better)

6 weeks: 17.5 (5.9)

6 months: 19.0 (6.1)

12 months: 17.6 (6.2)

18 months: 15.5 (4.7)

24 months: 16.4 (6.2)

6 weeks: 16.6 (6.1)

6 months: 17.9 (6.0)

12 months: 17.0 (4.1)

18 months: 19.8 (5.4)

24 months: 19.9 (5.0)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 weeks: 0.90 (‐1.63 to 3.43)

6 months: 1.10 (‐1.69 to 3.89)

12 months: 0.60 (‐2.12 to 3.32)

18 months: ‐4.30 (‐7.45 to ‐1.15)

24 months: ‐3.50 (‐7.84 to 0.84)

Positive mood

Philadelphia Geriatric Centre Affect Rating Scale (PGCARS) (mean (SD))

(higher scores = better)

6 weeks: 10.7 (3.5)

6 months: 10.9 (3.2)

12 months: 11.6 (3.1)

18 months: 11.5 (2.2)

24 months: 11.5 (2.4)

6 weeks: 11.3 (2.4)

6 months: 10.5 (2.6)

12 months: 11.9 (2.6)

18 months: 10.6 (2.9)

24 months: 11.0 (1.0)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 weeks: ‐0.60 (‐1.85 to 0.65)

6 months: 0.40 (‐0.92 to 1.72)

12 months: 0.30 (‐1.82 to 1.22)

18 months: 0.90 (‐0.71 to 2.51)

24 months: 0.50 (‐0.83 to 1.83)

Negative mood

Philadelphia Geriatric Centre Affect Rating Scale (PGCARS) (mean (SD))

(lower scores = better)

6 weeks: 5.8 (2.3)

6 months: 6.1 (2.6)

12 months: 7.3 (3.2)

18 months: 6.3 (3.1)

24 months: 6.4 (2.9)

6 weeks: 7.0 (2.9)

6 months: 6.7 (2.6)

12 months: 6.2 (2.0)

18 months: 6.6 (2.2)

24 months: 9.1 (2.5)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 weeks: ‐1.20 (‐2.31 to ‐0.09)

6 months: ‐0.60 (‐1.80 to 0.60)

12 months: 1.10 (‐0.27 to 2.47)

18 months: ‐0.30 (‐1.92 to 0.32)

24 months: ‐2.70 (‐4.80 to ‐0.60)

Agitation

Cohen‐Mansfield Agitation Inventory (CMAI) (mean (SD))

(lower scores = better)

6 weeks: 37.1 (11.1)

6 months: 44.0 (18.0)

12 months: 46.0 (18.0)

18 months: 42.0 (14.0)

24 months: 49.0 (15.0)

6 weeks:37.1 (10.9)

6 months: 47.0 (19.0)

12 months: 48.0 (18.0)

18 months: 47.0 (15.0)

24 months: 58.0 (16.0)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 weeks: ‐0.16 (‐0.45 to 0.14)

6 months: ‐0.16 (‐0.62 to 0.30)

12 months: ‐0.11 (‐0.65 to 0.43)

18 months:‐0.34 (‐0.96, 0.28)

24 months: ‐0.57 (‐1.37, 0.24)

Figuras y tablas -
Analysis 5.1

Comparison 5: Lighting intervention  vs. control lighting, Outcome 1: Behaviour, mood and depression

Ir a la figura de la revisión

Comparison 5: Lighting intervention  vs. control lighting, Outcome 2: Behaviour, mood and depression: depression 4‐6 weeks

Figuras y tablas -
Analysis 5.2

Comparison 5: Lighting intervention  vs. control lighting, Outcome 2: Behaviour, mood and depression: depression 4‐6 weeks

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5: Lighting intervention  vs. control lighting, Outcome 3: Behaviour, mood and depression: agitation 4‐6 weeks

Figuras y tablas -
Analysis 5.3

Comparison 5: Lighting intervention  vs. control lighting, Outcome 3: Behaviour, mood and depression: agitation 4‐6 weeks

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5: Lighting intervention  vs. control lighting, Outcome 4: Function 4‐6 weeks

Figuras y tablas -
Analysis 5.4

Comparison 5: Lighting intervention  vs. control lighting, Outcome 4: Function 4‐6 weeks

Ir a la figura de la revisiónAbrir en una pestaña nueva

Function

Study

Measure

Lighting intervention

Control

Sample size

Effect estimate

Riemersma‐vanDerLek 2008

Nurse‐informant adaptation (NI‐ADL) of the scale by Katz et al (mean (SD))

(lower scores = better)

6 months: 20.0 (14.0)

12 months: 17.0 (12.0)

18 months: 17.0 (14.0)

24 months: 13.0 (11.0)

6 months: 22.0 (12.0)

12 months: 22.0 (11.0)

18 months: 27.0 (14.0)

24 months: 29.0 (14.0)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 months: ‐0.15 (‐0.61 to 0.31)

12 months: ‐0.42 [‐0.97, 0.12]

18 months: ‐0.70 (‐1.34 to ‐0.06)

24 months: ‐1.27 (‐2.14 to ‐0.39)

Figuras y tablas -
Analysis 5.5

Comparison 5: Lighting intervention  vs. control lighting, Outcome 5: Function

Ir a la figura de la revisión

Global cognitive function

Study

Measure

Lighting intervention

Control

Sample size

 Effect estimate

Riemersma‐vanDerLek 2008

Mini‐mental state examination (MMSE) (mean (SD))

(higher scores = better)

6 weeks: 14.5 (6.2)

6 months: 16.6 (5.5)

12 months: 15.6 (5.2)

18 months: 16.2 (4.5)

24 months: 17.4 (3.7)

6 weeks: 14.3 (7.0)

6 months: 15.4 (7.3)

12 months: 15.6 (6.4)

18 months: 14.5 (5.4)

24 months: 13.7 (7.4)

6 weeks: 87

6 months: 74

12 months: 55

18 months: 41

24 months: 26

MD (95% confidence interval):

6 weeks: 0.20 (‐2.48 to 2.88)

6 months: 1.20 (‐1.56 to 3.96)

12 months: 0.00 (‐2.74 to 2.74)

18 months: 1.70 (‐1.03 to 4.43)

24 months: 3.70 (‐0.04 to 7.44)

Figuras y tablas -
Analysis 5.6

Comparison 5: Lighting intervention  vs. control lighting, Outcome 6: Global cognitive function

Ir a la figura de la revisión

Quality of life

Study

Measure

Dining space redesign

Traditional

Sample size

Effect estimate or reported significance

Mathey 2001

Sickness Impact Profile (SIP) (mean percentage change (SD))

(higher scores = better)

‐2% (11%)

‐13% (12%)

16

P < 0.05 in control group

Authors reported values "stayed stable" in intervention group

Dutch version of the Philadelphia Geriatric Center Moral Scale (PGCMS) (mean percentage change (SD))

(higher scores = better)

‐3% (20%)

‐2% (19%)

16

Authors reported values remained "relatively stable", no P values reported

Nijs 2006

Dutch quality of life of somatic nursing home residents questionnaire 

(higher scores = better)

N/R

N/R

178

MD (95% confidence interval):

6.10 (2.10 to 10.10)

Figuras y tablas -
Analysis 6.1

Comparison 6: Dining space redesign vs. traditional environment, Outcome 1: Quality of life

Ir a la figura de la revisión

Behaviour, mood and depression

Study

Measure

Dining space redesign

Traditional

Sample size

Reported significance

Kenkmann 2010

Hospital Anxiety and Depression Scale (HADS), (unadjusted mean (SD))

(lower scores = better)

Baseline: 4.07 (3)

12 months: 4.86 (4.61)

Baseline: 6.3 (4.45)

12 months: 6.78 (3.83)

120

N/R

Figuras y tablas -
Analysis 6.2

Comparison 6: Dining space redesign vs. traditional environment, Outcome 2: Behaviour, mood and depression

Ir a la figura de la revisión

Function

Study

Measure

n

Effect estimate

Nijs 2006

Nursing home physical performance test

(higher scores = better)

178

MD (95% confidence interval):

3.20 (0.90 to 5.50)

Figuras y tablas -
Analysis 6.3

Comparison 6: Dining space redesign vs. traditional environment, Outcome 3: Function

Ir a la figura de la revisión

Global cognitive function

Study

Measure

Dining space redesign

Traditional

Sample size

Reported significance

Kenkmann 2010

Mini‐Mental State Examination (MMSE) (unadjusted mean (SD))

(higher scores = better)

Baseline: 19 (5.6)

12 months: 17 (6.2)

Baseline: 17 (6.2)

12 months: 15 (7.9)

56

P > 0.05

Kenkmann 2010

MMSE, cognitive impairment <= 23, %

Baseline: 83.3%

12 months: 81.5%

Baseline: 87.5%

12 months: 79.2%

54

P > 0.05

Figuras y tablas -
Analysis 6.4

Comparison 6: Dining space redesign vs. traditional environment, Outcome 4: Global cognitive function

Ir a la figura de la revisión

Serious adverse effects

Study

Measure

Dining space redesign

Traditional

Sample size

Effect estimate or reported significance

Kenkmann 2010

Fall within previous year, %

Baseline: 60%

12 months: 60%

Baseline: 56%

12 months: 50%

105

P > 0.05

Rate of falls

N/R

N/R

105

Rate ratio (95% confidence interval):

0.76 (0.57 to 1.01)

Figuras y tablas -
Analysis 6.5

Comparison 6: Dining space redesign vs. traditional environment, Outcome 5: Serious adverse effects

Ir a la figura de la revisión

Behaviour, mood and depression

Study

Measure

Garden vignette

Traditional

Sample size

Effect estimate

Marcy‐Edwards 2011

Neuropsychiatric Inventory‐Nursing Homes (NPI, NH), (mean change (SD))

(lower scores = better)

12.4 (66.1)

‐0.4 (19)

33

MD (95% confidence interval):

12.8 (‐10.7 to 36.3)

Figuras y tablas -
Analysis 7.1

Comparison 7: Garden vignette vs. traditional environment, Outcome 1: Behaviour, mood and depression

Ir a la figura de la revisión
Summary of findings 1. Whole‐facility changes: Home‐like models compared to traditional environment for older people living in long‐term residential care

Whole‐facility changes: Home‐like models compared to traditional environment for older people living in long‐term residential care

Patient or population: older adults living in long‐term residential care including, but not limited to, dementia‐specific care settings
Settings: long‐term residential care
Intervention: home‐like models (features of home‐like models may include buildings which limit the capacity of the living units to small numbers of residents, designs to encourage the participation of residents with domestic activities and a person‐centred care approach)
Comparison: traditional design (traditional design may include larger‐scale buildings with a larger number of residents, hospital‐like features such as nurses' stations, traditional hierarchical organisational structures and design which prioritises safety)

Outcomes

 

Illustrative comparative risks (95% CI)

Relative effect
(95% CI)

Follow‐up time

No of Participants
(studies)

 

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Traditional design

Corresponding risk 

Home‐like model

Health‐related quality of life 

Dementia‐specific quality of life measure (QUALIDEM) 

(higher scores = better)

 

N/a

N/a

Not estimable

6 months and 12 months

 

 

 

 

 

 

 

 

33 (1 controlled before‐after study)

⊕⊝⊝⊝
very low1

2 domains (feeling at home and care relationship) were examined in an analysis adjusted for baseline differences between the groups; 7 other domains were unadjusted. The author stated "No statistically significant differences were observed between the intervention and control groups."

Global behaviour

Neuropsychiatric Inventory (NPI),

Neuropsychiatric Inventory‐Nursing Home version (NPI‐NH) and

Nurses Observations Scale for Geriatric Patients (NOSGER)

(lower scores = better)

 

 

N/a

N/a

Not estimable

6 months

 

 

 

 

 

 

 

 

 

 

 

 

 

 

257
(3 controlled before‐after studies)

⊕⊝⊝⊝
very low2

 

One study found little or no difference in global behaviour change at 6 months using the NPI (N = 164; MD ‐0.04 (95% CI ‐0.13 to 0.04)); two additional studies (N = 93) reported global behaviour endpoint data, but the data were unsuitable for determining a summary effect estimate. 

 

 

 

 

 

 

 

Depression

Revised Memory and Behaviour Problems Checklist (RMBPC) and

Mood Scale Score (MSS)

(lower scores = better)

 

N/a

N/a

Not estimable

6 months and 18 months

 

406 (2 controlled before‐after studies)
 

⊕⊝⊝⊝
very low3

Depressive symptoms 18‐month change using the MSS (1 study, N = 242; RR 1.15 (95% CI 1.02 to 1.29))

Probability no depressive symptoms 18 months using the MSS (1 study, N = 242; OR 0.36 (95% CI 0.12 to 1.07))

Depressive symptoms 6‐month endpoint using the RMBPC (1 study, N = 164; MD 0.01 (95% CI ‐0.12 to 0.14))

Function

Activities of daily living (ADL) long‐form scale (lower scores = better), Interview for the Deterioration of Daily Living activities in Dementia (IDDD) (lower scores = better)

Or Barthel Index (higher scores = better)

 

 

N/a

N/a

Not estimable

6 months and 18 months

499
(4 controlled before‐after studies)

⊕⊝⊝⊝
very low4

Function 18‐month change using the ADL long‐form scale (1 study, N = 242; MD ‐0.09 (95% CI ‐0.46 to 0.28))

Function 6‐month endpoint using the IDDD (1 study, N = 164; MD ‐4.37 (95% CI ‐7.06 to ‐1.69))

Two additional studies: measured function with the Barthel Index but were not included in the quantitative analysis:

  • One study (data were insufficient): authors stated: "interactions between settings and development over time could not be proved".

  • One study (results were not adjusted for differences in baseline characteristics): authors stated function declined in both the intervention and control groups but "more sharply" in control group.

Serious adverse effects

Physical restraints, reported as percentage points (lower = better)

 

23 per 1000*

20 per 1000**

MD ‐0.3% (‐0.5% to ‐0.1%)

Follow‐up: Unclear

 

Unclear (weighted estimate 74,449 participants at enrolment)
(1 study)

 

⊕⊝⊝⊝
very low5

 

No further adverse effects were examined.

Unclear length of follow‐up (reported as up to 5 years)

 

CI: Confidence interval; MD: Mean difference;OR: Odds Ratio; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 The certainty of evidence was downgraded two levels for risk of bias (high risk of bias on six items including high risk of selection bias, performance bias, detection bias, attrition bias, and other (differences in baseline characteristics and potential residual confounding)) and two levels for imprecision (only 33 participants).

2The certainty of evidence was downgraded two levels for risk of bias (all studies at high risk of bias on at least six items) and one level for imprecision (< 400 participants).

3The certainty of evidence was downgraded two levels for risk of bias (all studies at high risk of bias on six items).

4The certainty of evidence was downgraded two levels for risk of bias (high risk of bias on at least six items) and one level for imprecision (499 participants in total across outcomes but reported across different measures).

5The certainty of evidence was downgraded two levels for risk of bias (high risk of bias on five items including high risk of selection bias, performance bias, detection bias and other (method of selection of facilities unclear, potential residual confounding, significant differences in baseline characteristics and significant differences for many baseline outcome measures)).

*Assumed risk for the control group was derived from the study reporting this outcome (2.3%).

**Corresponding risk based on a difference of 0.3%.
Figuras y tablas -
Summary of findings 1. Whole‐facility changes: Home‐like models compared to traditional environment for older people living in long‐term residential care
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Comparison 1. Home‐like vs. traditional environment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Quality of life Show forest plot

1

Other data

No numeric data

1.2 Behaviour, mood and depression Show forest plot

5

Other data

No numeric data

1.2.1 Global behaviour

3

Other data

No numeric data

1.2.2 Depression

2

Other data

No numeric data

1.2.3 Behaviour subdomains

2

Other data

No numeric data

1.2.4 Social engagement

2

Other data

No numeric data

1.3 Function Show forest plot

4

Other data

No numeric data

1.4 Global cognitive function Show forest plot

4

Other data

No numeric data

1.5 Quality of care  Show forest plot

1

Other data

No numeric data

1.6 Serious adverse effects Show forest plot

1

Other data

No numeric data
Figuras y tablas -
Comparison 1. Home‐like vs. traditional environment
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Comparison 2. Refurbishment vs. traditional environment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Quality of life Show forest plot

3

Other data

No numeric data

2.2 Behaviour, mood and depression Show forest plot

3

Other data

No numeric data

2.2.1 Depression

1

Other data

No numeric data

2.2.2 Behaviour subdomains

3

Other data

No numeric data

2.3 Function Show forest plot

1

Other data

No numeric data

2.4 Quality of care Show forest plot

1

Other data

No numeric data
Figuras y tablas -
Comparison 2. Refurbishment vs. traditional environment
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Comparison 3. Special‐care units for dementia vs. traditional environment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Behaviour, mood and depression Show forest plot

1

Other data

No numeric data

3.1.1 Global behaviour

1

Other data

No numeric data

3.1.2 Depression

1

Other data

No numeric data

3.1.3 Behaviour subdomains

1

Other data

No numeric data

3.2 Function Show forest plot

1

Other data

No numeric data

3.3 Global cognitive function Show forest plot

1

Other data

No numeric data
Figuras y tablas -
Comparison 3. Special‐care units for dementia vs. traditional environment
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Comparison 4. Group living corridor vs. group living non‐corridor design

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Behaviour, mood and depression Show forest plot

1

Other data

No numeric data

4.1.1 Depression

1

Other data

No numeric data

4.1.2 Behaviour subdomains

1

Other data

No numeric data
Figuras y tablas -
Comparison 4. Group living corridor vs. group living non‐corridor design
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Comparison 5. Lighting intervention  vs. control lighting

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Behaviour, mood and depression Show forest plot

2

Other data

No numeric data

5.1.1 Global behaviour

1

Other data

No numeric data

5.1.2 Depression

1

Other data

No numeric data

5.1.3 Behaviour subdomains

2

Other data

No numeric data

5.2 Behaviour, mood and depression: depression 4‐6 weeks Show forest plot

3

291

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.22 [‐0.45, 0.01]

5.3 Behaviour, mood and depression: agitation 4‐6 weeks Show forest plot

2

179

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.16 [‐0.45, 0.14]

5.4 Function 4‐6 weeks Show forest plot

2

179

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.59, 0.00]

5.5 Function Show forest plot

1

Other data

No numeric data

5.6 Global cognitive function Show forest plot

1

Other data

No numeric data
Figuras y tablas -
Comparison 5. Lighting intervention  vs. control lighting
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Comparison 6. Dining space redesign vs. traditional environment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Quality of life Show forest plot

2

Other data

No numeric data

6.2 Behaviour, mood and depression Show forest plot

1

Other data

No numeric data

6.3 Function Show forest plot

1

Other data

No numeric data

6.4 Global cognitive function Show forest plot

1

Other data

No numeric data

6.5 Serious adverse effects Show forest plot

1

Other data

No numeric data
Figuras y tablas -
Comparison 6. Dining space redesign vs. traditional environment
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Comparison 7. Garden vignette vs. traditional environment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Behaviour, mood and depression Show forest plot

1

Other data

No numeric data
Figuras y tablas -
Comparison 7. Garden vignette vs. traditional environment
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